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General NPI Number Information
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NPI Number | 1326219924
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Entity Type | Individual
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Provider Name | SVETLANA FOMIN MD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 755 MEMORIAL PKWY STE 302A
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2771
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Country | US
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Telephone | 484-526-7300
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Fax | 866-449-5832
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Provider Business Mailing Address
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Address Line | 113 AUSTIN ST
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City | TINTON FALLS
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State | NJ
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Zip | 07712-7760
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Country | US
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Telephone | 732-685-1566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25MA08122400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 309596
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License Number State | NY
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